Walsh & Hoyt: Convergence-Retraction Nystagmus

So-called convergence-retraction nystagmus is characterized by quick phases that converge or retract the eyes on attempts to look up. It is elicited either by asking the patient to make an upward saccade or by using a handheld optokinetic drum or tape and moving the stripes or figures down. This maneuver produces slow, downward, pursuit eye movements, but upward quick phases are replaced by rapid convergent movements, retractory movements, or both. Affected patients usually have impaired or absent upward gaze for both pursuit and saccadic eye movements; however, in some cases upward pursuit appears normal, whereas upward saccades are obviously abnormal. Convergence-retraction nystagmus is commonly produced by lesions of the mesencephalon that damage the posterior commissure, such as pineal tumors.